Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 12/2011

01-12-2011 | Symposium: Fractures of the Shoulder Girdle

Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

Authors: Crispin Ong, MD, Christopher Bechtel, BA, Michael Walsh, PhD, Joseph D. Zuckerman, MD, Kenneth A. Egol, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2011

Login to get access

Abstract

Background

Locking plates have become a commonly used fixation device in the operative treatment of three- and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures.

Questions/purposes

We compared functional scores, ROM, and radiographs in patients with one-part proximal humerus fractures treated nonoperatively to those in patients with displaced three- and four-part proximal humerus fractures treated with open reduction and internal fixation using locking plates.

Patients and Methods

We retrospectively reviewed 142 patients with proximal humerus fractures treated with a standardized treatment algorithm over a 6-year period. Three- and four-part fractures were treated surgically while one-part fractures were treated nonoperatively. Functional scores, ROM, and radiographs were used to evaluate outcomes. American Shoulder and Elbow Surgeons and SF-36 scores were obtained at 12 months. Of the 142 patients, 101 (51 with three- or four-part fractures and 50 with one-part fractures) had a minimum followup of 12 months (average, 19 months; range, 12–64 months).

Results

The fractures united in all patients. At 1 year, the patients with one-part fractures had better SF-36 physical and mental scores and American Shoulder and Elbow Surgeons scores than the three- and four-part fractures. Both groups had similar shoulder ROM. Nine patients treated operatively had complications, four of which were related to screw penetration into the joint.

Conclusions

Patients with three- and four-part fractures should be advised of the likelihood of persistent functional impairment and a relatively higher risk of complications when treated operatively with locked plates.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Agudelo J, Schurmann M, Stahel P, Helwig P, Morgan SJ, Zechel W, Bahrs C, Parekh A, Ziran B, Williams A, Smith W. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma. 2007;21:676–681.PubMedCrossRef
2.
Antuna SA, Sperling JW, Cofield RH. Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg. 2008;17:202–209.PubMedCrossRef
3.
Bjorkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75:741–745.PubMedCrossRef
4.
Clifford PC. Fractures of the neck of the humerus: a review of the late results. Injury. 1980;12:91–95.PubMedCrossRef
5.
Cruess RL. Corticosteroid-induced osteonecrosis of the humeral head. Orthop Clin North Am. 1985;16:789–796.PubMed
6.
Dietrich M, Meier C, Lattmann T, Zingg U, Gruninger P, Platz A. [Complex fracture of the proximal humerus in the elderly: locking plate osteosynthesis vs hemiarthroplasty] [in German]. Chirurg. 2008;79:231–240.PubMedCrossRef
7.
Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22:159–164.PubMedCrossRef
8.
Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res. 2005;430:176–181.PubMedCrossRef
9.
Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21:185–191.PubMedCrossRef
10.
Gerber C, Werner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86:848–855.PubMedCrossRef
11.
Goldman RT, Koval KJ, Cuomo F, Gallagher MA, Zuckerman JD. Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. J Shoulder Elbow Surg. 1995;4:81–86.PubMedCrossRef
12.
Handschin AE, Cardell M, Contaldo C, Trentz O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury. 2008;39:306–313.PubMedCrossRef
13.
Horak J, Nilsson BE. Epidemiology of fracture of the upper end of the humerus. Clin Orthop Relat Res. 1975;112:250–253.PubMedCrossRef
14.
Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res. 2006;442:115–120.PubMedCrossRef
15.
Koval KJ, Gallagher MA, Marsicano JG, Cuomo F, McShinawy A, Zuckerman JD. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997;79:203–207.PubMed
16.
Kristiansen B, Christensen SW. Proximal humeral fractures: late results in relation to classification and treatment. Acta Orthop Scand. 1987;58:124–127.PubMedCrossRef
17.
Krivohlavek M, Lukas R, Taller S, Sram J. [Use of angle-stable implants for proximal humeral fractures: prospective study] [in Czech]. Acta Chir Orthop Traumatol Cech. 2008;75:212–220.PubMed
18.
Lill H, Hepp P, Rose T, Konig K, Josten C. [The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach—technique and first results] [in German]. Zentralbl Chir. 2004;129:43–48.PubMedCrossRef
19.
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L. Fracture and Dislocation Classification Compendium-2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee. J Orthop Trauma. 2007;21:S1–S133.PubMedCrossRef
20.
Neer CS 2nd. Displaced proximal humeral fractures. Part I. Classification and evaluation. By Charles S. Neer, I, 1970. Clin Orthop Relat Res. 1987;223:3–10.PubMed
21.
Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am. 2008;90:233–240.PubMedCrossRef
22.
Plecko M, Kraus A. Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol. 2005;17:25–50.PubMedCrossRef
23.
Sallay PI, Reed L. The measurement of normative American Shoulder and Elbow Surgeons scores. J Shoulder Elbow Surg. 2003;12:622–627.PubMedCrossRef
24.
Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009;91:1689–1697.PubMedCrossRef
25.
Strohm PC, Helwig P, Konrad G, Sudkamp NP. Locking plates in proximal humerus fractures. Acta Chir Orthop Traumatol Cech. 2007;74:410–415.PubMed
26.
Tejwani NC, Liporace F, Walsh M, France MA, Zuckerman JD, Egol KA. Functional outcome following one-part proximal humeral fractures: a prospective study. J Shoulder Elbow Surg. 2008;17:216–219.PubMedCrossRef
27.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483.PubMedCrossRef
28.
Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919–1925.PubMed
29.
Zuckerman JD, Matsen FA 3rd. Complications about the glenohumeral joint related to the use of screws and staples. J Bone Joint Surg Am. 1984;66:175–180.PubMed
Metadata
Title
Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures
Authors
Crispin Ong, MD
Christopher Bechtel, BA
Michael Walsh, PhD
Joseph D. Zuckerman, MD
Kenneth A. Egol, MD
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 12/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-011-1864-4

Other articles of this Issue 12/2011

Clinical Orthopaedics and Related Research® 12/2011 Go to the issue

Symposium: Fractures of the Shoulder Girdle

Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

Surgical Technique

Surgical Technique: Static Intramedullary Nailing of the Femur and Tibia Without Intraoperative Fluoroscopy

Symposium: Fractures of the Shoulder Girdle

The Classic: A Dissertation Upon Dislocations and Fractures of the Clavicle and Shoulder-Joint

Letter to the Editor

Letter to the Editor: The Effect of Long-term Alendronate Treatment on Cortical Thickness of the Proximal Femur

Reply to Letter to the Editor

Reply to Letter to the Editor: The Cam-type Deformity of the Proximal Femur Arises in Childhood in Response to Vigorous Sporting Activity

In Brief

In Brief: Closed Tibial Shaft Fractures